Healthcare Provider Details

I. General information

NPI: 1497341168
Provider Name (Legal Business Name): TRINITY INTEGRATED CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2020
Last Update Date: 12/17/2020
Certification Date: 12/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4637 S 7TH ST
PHOENIX AZ
85040-2219
US

IV. Provider business mailing address

4637 S 7TH ST
PHOENIX AZ
85040-2219
US

V. Phone/Fax

Practice location:
  • Phone: 602-456-0769
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State

VIII. Authorized Official

Name: LIZ GRANT
Title or Position: PRIMARY CONTACT
Credential:
Phone: 602-456-0769